Selected Abstracts from the Orthoptics Australia 73Rd Annual Scientific Conference Held in Melbourne 20Th to 22Nd November 2016

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Selected Abstracts from the Orthoptics Australia 73rd Annual Scientific Conference held in Melbourne 20th to 22nd November 2016

PATRICIA LANCE LECTURE strabismus. The overall prevalence of strabismus was not significantly 50 YEARS: THE DEVELOPMENT OF RESEARCH AND PUBLICATION IN different between ethnicities (p=0.81). However, in European Caucasian THE AUSTRALIAN ORTHOPTIC JOURNAL populations 62.6% had esotropia while 74.3% of those in East Asian populations had exotropia. Modifiable risk factors such as low socio- Linda Santamaria economic status, maternal exposure to smoking, low birth weight, prematurity and admission to neonatal intensive care units have been This lecture is presented in honour and memory of Patricia Mary Lance previously identified. Esotropia is associated with antenatal factors, such in recognition of her contribution to orthoptics in the fields of research, as admission to NICU and low birth weight, whereas exotropia is related to education, and the Association both in Australia and internationally. After modifiable risk factors such as low socio-economic status. seven years of publishing the transactions of the annual scientific meetings, the first titled edition of the Australian Orthoptic Journal was published Conclusions: While the prevalence of strabismus is consistent across in 1966 as Volume 8, which means that this year marks 50 years of our different locations, there is variation in the prevalence of esotropia and journal with its current name. This anniversary provided an opportune exotropia based on ethnicity. A family history of strabismus increases the time to look back over the journal and its development over the decades, risk of developing strabismus, but in itself is unable to account for the from the very first orthoptic paper in the transactions of the 1959 meeting, majority of strabismus cases. The contributions of modifiable risk factors which was actually by Patricia Lance, to the latest research publications appear to play a major role in the development of esotropia and exotropia in 2015. Over this time the changes in society, culture, education and in children. However ethnic differences in esotropia and exotropia are technology have all affected the development of research and this has been unexplained by any of these risk factors. reflected in our journal. UNDERSTANDING THE RELATIONSHIP BETWEEN INCOMITANT REVIEW OF THE PREVALENCE OF STRABISMUS AND FACTORS STRABISMUS AND THE RADIOLOGICAL FINDINGS CONTRIBUTING TO VARIATION Natalie Ainscough, Gulsah Bakar, Nermina Mustafic, Jessica Collins Felicia Adinanto, Amanda French, Kathryn Rose Using case studies seen in ophthalmology departments run by South Strabismus presents in 2-5% of the population and is highly associated Australia Health, the interpretation of a range of radiological assessments was presented, including MRI and CT scans, and their relationship to eye Figure 1a. Humphrey visual field right eye. Figure 1b. Humphrey visual field left eye. with amblyopia. It is known that those with poor vision in one eye are more likely to have pathology in the better eye later in life, contributing movement deficits identified in the outpatient clinic. to the proportion of those with vision impairment with age. Literature has established that the contribution of genetics to strabismus is approximately THE SAFETY AND EFFICACY OF CORNEAL COLLAGEN CROSS LINKING 30% with associations between strabismus and various craniofacial and COMBINED WITH ORTHOKERATOLOGY LENSES FOR KERATOCONUS global syndromes. Environmental risk factors such as low economic status, maternal exposure to smoking, low birth weight, prematurity Mitchell Bagley, Tess Huynh and admission to neonatal intensive care units have been identified as modifiable risk factors. This raises the question of whether the prevalence Purpose: To evaluate the results of corneal collagen cross linking (CXL) of strabismus has varied over decades. In order to determine this and alone compared to when CXL is performed in combination with corneal whether the contribution of demographic characteristics of the population, moulding orthokeratology (OK) lenses for progressive keratoconus. such as age and ethnicity and methods of sampling and testing across populations has caused variation in the recorded prevalence of strabismus, Method: A pilot study was conducted involving patients who presented this has been assessed by systematic analysis of the available literature. with progressive keratoconus and proceeded with treatment of either CXL alone or CXL with OK wear. Patients who were treated using OK lenses Papers presenting the prevalence of strabismus within various population wore these for a minimum of one month prior to CXL and resumed OK samples have been identified through database searches of PubMED and wear one month postoperatively, continuing until vision had stabilised. MEDLINE. Search terms included prevalence, strabismus, risk factors, The same accelerated CXL protocol was followed for all cases. Vision, school-based and population. Papers were selected for analysis if the autorefraction, keratometry and pachymetry were obtained throughout samples were either population-based or school-based and the method of the study. detection was by cover test by a qualified practitioner. Results: There were 10 eyes in each group. In both groups VA improved by seven letters and there was no progression across all keratometric Figure 2a. OCT right eye. Figure 2b. OCT left eye. RISK FACTORS FOR ESOTROPIA AND EXOTROPIA indicators between the preoperative appointment and the most recent appointment post CXL. Mean best corrected visual acuity indicated a Felicia Adinanto, Amanda French, Kathryn Rose slightly greater improvement in the OK group of three letters compared to one. The mean minimum pachymetry revealed greater thickening in Purpose: To identify risk factors associated with the development of the OK group (+23.22um) compared to the control group (+12.13um). esotropia and exotropia, which may have contributed to trends observed in Two patients in each group appreciated an improvement in their vision, the prevalence over the past few decades. however three patients who wore OKs reported ocular discomfort. There Methods: A systematic literature review was performed to provide insight were no adverse advents in either group. into the relative contribution of genetics and modifiable risk factors in the Conclusion: Given the similarity in results between CXL alone and development of esotropia and exotropia in children. combining this procedure with OK wear it is difficult to ascertain what Results: Genetic studies of strabismus have established that the risk of place this treatment option has in the current clinical context. It is likely developing esotropia is 3 to 5 times greater if a first degree relative had that a higher-powered study may reveal more significant findings.

Fitzpatrick: NDIS: implications for orthoptic practice: Aust Orthopt J 2016 Vol 48 © Orthoptics Australia Aust Orthopt J 2016 Vol 48 © Orthoptics Australia 36 AUSTRALIAN ORTHOPTIC JOURNAL AUSTRALIAN ORTHOPTIC JOURNAL

THE EVALUATION OF PATIENT EDUCATION AND THE PROVISION CHALLENGING OUR THINKING ON AMBLYOPIA: A PARADIGM SHIFT Empire Air-Training Scheme. Consequently, Australian orthoptists, suggested that minor modifications to the vision screening tool along with OF INFORMATION REGARDING PATIENT SUPPORT GROUPS AND Beatrice Barnes, Ethel D’Ombrain, Diana (Mann) Craig, Emmie Russell and an education package will enhance its overall functionality. LOW VISION SERVICES TO PATIENTS RECEIVING TREATMENT FOR Louise Brennan, Jane Lock Lucy (Willoughby) Retalic assessed and treated RAAF aircrew with ocular NEOVASCULAR AMD motor imbalances from 1940-45. Little has been written about this period Amblyopia is fundamentally a neurological disorder resulting in subnormal in Australian orthoptic history. To my knowledge there are no personal EXPLORING THE PATIENT PERSPECTIVE OF CATARACT SURGICAL vision that arises from disruption of visual development during early records written by these orthoptists. Much of what we know is through OUTCOMES Jessica Boyle, Meri Vukicevic, Konstandina Koklanis, Catherine childhood. Amblyopia, which is more commonly referred to as ‘lazy eye’ Itsiopoulos, Gwyneth Rees scientific papers and some accounts by ophthalmologists and RAAF affects about 2% of the Australian population. The current mainstay of personnel. Nevertheless, there is sufficient evidence to show that these Vu Quang Do, Lisa Keay, Anna Palagyi, Jan Steen, Andrew White, Background: Central to the patient experience of ophthalmic treatment is treatment is occlusion therapy, which involves patching or penalisation women played an important part in aviation medicine. Peter McCluskey patient education. Despite the chronic and invasive nature of anti-vascular of the non-amblyopic eye. Some scientists and clinicians purport that endothelial growth factor (VEGF) treatment for neovascular age-related whilst patching improves monocular vision, it neglects binocular visual Background: Success of cataract surgery has traditionally been assessed by macular degeneration (AMD), the perceptions of patients around patient development. The latter is important for depth perception, and appreciation BEFORE I WAS BORN visual acuity and vision function measures. However, little is known about education have not been widely investigated in this clinical population. of form and motion. Recent experimental evidence supports the role of the relationship between these clinical outcomes and patient satisfaction Of the handful of studies to have explored this to date, all have been binocular methods of treating amblyopia, referred to as dichoptic therapy. Kirsten Campbell following cataract extraction. limited by small sample size. These studies have reported that patients This treatment method forces both eyes to function together by presenting Prior to the development of computerised perimetry, monitoring glaucoma Purpose: This study aims to identify the main predictors of patient receive inadequate information pertaining to the injection procedure and different images to each eye, either in a movie or as an interactive game. satisfaction following cataract surgery and to explore how satisfaction and its outcomes. Improving patient education standards may help minimise involved measuring IOP, often by Schiotz tonometry and performing fields The amblyopic eye sees images of higher contrast, while the fellow eye quality of life is related to key visual outcomes such as visual acuity and known pre-procedural anxiety often experienced in those undergoing anti- with a Bjerrum screen or arc perimeter. Pilocarpine was the standard sees images of lower contrast. For the game to be played successfully both vision-related quality of life. VEGF treatment for neovascular AMD. In addition, no study to date has images must be seen. Multiple small studies have already demonstrated treatment for glaucoma with the resulting miosis reducing the field. investigated issues surrounding the provision of information to patients in the efficacy of dichoptic tablet games for visual improvement in amblyopes. Refracting patients after cataract surgery meant waiting for 6 to 8 weeks Methods: The aim is to recruit 400 bilateral cataract patients aged 50 relation to patient support groups/low vision services from the perspective Our current thinking on amblyopia and how this is being challenged will be for the large wound to heal and refraction to stabilise. Aphakic correction years and above currently on the cataract surgery waiting list at four of ophthalmologists and orthoptists involved in patient care. The aim of discussed along with an outline of a prospective study being conducted at required patience and continued explanation to gain an accurate refraction. public hospitals and one private clinic in Sydney. Participants will undergo this study was to investigate the experiences and perceptions of patients The Children’s Hospital at Westmead. The artist Monet exemplified difficulties following cataract surgery and his comprehensive assessment of vision, self-reported visual function, quality undergoing repeated intravitreal anti-VEGF injections for neovascular AMD rejection of what was then a satisfactory result. of life and mood prior to first eye surgery, three months after first-eye in relation to patient education. A secondary aim was to identify issues surgery and three months after second-eye surgery. Satisfaction with surrounding patient education and the provision of information relating INVESTIGATING A FEAR OF THE DARK - ERG FINDINGS IN CHILDREN surgery will be rated by the participant, and target post-surgical refractive to low vision services and patient support groups from the perspective of WITH NYCTALOPIA NOT YOUR AVERAGE SQUINT... status and surgical complications assessed by surgical record review. ophthalmologists and orthoptists. Results: 330 participants have undergone baseline assessment as of July Nick Brislane Nicole Carter Methods: Forty patients (16 males, 24 females) with neovascular 2015, with 27% (n=90) having completed follow-up assessment post first- AMD undergoing anti-VEGF treatment were recruited from a private Objective: To report on the clinical phenotypes in a series of children who In a paediatric setting doing initial examinations on patients with a eye surgery. One-third (n=28) of participants were dissatisfied with their ophthalmology practice and public hospital in Melbourne. Patients presented with complaints of night blindness. possible strabismus becomes as routine as brushing your teeth. From the self-reported wait-time from initial hospital appointment to surgery date underwent semi-structured, one-on-one interviews. Interview topics information on the referral and the parent’s description of eye signs, the (median 6 months, range 1-18 months); median preferred waiting time included: treatment burden and satisfaction; tolerability; barriers to Discussion: During the commissioning of the visual electrophysiology orthoptist usually has a good idea of one or two differential diagnoses as was 4.5 months (range 0.5-12 months). Most participants (91%, n=82) adherence; treatment motivation; and patient education. Interviews testing service at The Royal Children’s Hospital, 10 patients underwent soon as they enter the room. But every now and then a case presents were satisfied with their first-eye cataract surgery. were audio recorded and thematic analysis performed using NVivo 10 standard and extended electroretinogram (ERG) testing to investigate their that is not your average squint! This presentation showcased a selection (QSR International, Doncaster, Australia). Eighteen orthoptists and one common complaints of night blindness. Under scotopic test conditions, six of interesting squint cases. The details of each case were followed from Conclusion: Eliciting the personal perspective of cataract surgery may ophthalmologist with experience in managing patients with neovascular patients’ ERGs showed an absence of rod-derived b-waves, a negative referral to orthoptic and ophthalmic examination, diagnosis and follow-up. allow eye professionals to better determine the suitability of a patient for AMD were recruited from the same private ophthalmology clinic and response to a bright white stimulus. The use of photopic, cone-derived cataract surgery, manage expectations and appropriately time surgery. public eye hospital. Eye health care professionals completed a self- ERG to short and long duration flash stimuli assisted in differentiating administered electronic questionnaire designed by the study investigators between genetically distinct conditions which are indistinguishable based THE USE OF A TOOL TO DETECT THE PRESENCE OF VISION DEFECTS exploring their perceptions around patient education and the provision of on a negative ERG alone. ERG testing beyond the standard ISCEV protocols IN PATIENTS DIAGNOSED WITH STROKE – VISION SCREENING TOOL A CASE OF FOVEAL HYPOPLASIA information to patients about support groups/services. was informative in making distinctions between complete and incomplete VALIDATION RESULTS Results: Patient satisfaction in relation to the provision of educational congenital stationary night blindness (4 cases), retinitis pigmentosa (3 Allanah Crameri information was low, especially among public patients. Many patients cases), x-linked retinoschisis (1 case), enhanced s-cone syndrome (1 case) Michelle Courtney-Harris, Neryla Jolly, Kathryn Rose A four-year-old boy was referred to the clinic for poor visual acuity which reported receiving inadequate information about AMD and its treatment. and rod dysfunction secondary to isotretinoin use (1 case). Aim: To validate a vision screening tool for use by hospital-based health the optometrist was unable to improve. On further investigations by the Visual feedback in the form of optical coherence tomography (OCT) Conclusion: ERG studies beyond the ISCEV standard protocols are useful orthoptist and ophthalmologist, foveal hypoplasia was suspected. Foveal imaging was perceived by patients to represent a useful adjunct to verbal practitioners in stroke-affected patients to identify pre-existing and stroke- in diagnosing various causes of nyctalopia in children. related ocular conditions. hypoplasia is the underdevelopment of the fovea and macula which information conveyed by their specialist and facilitated their understanding includes an absent or abnormal maculofoveal reflex, unclear definition of treatment. However, not all patients reported having been shown their Methods: A vision screening tool was devised in consultation with of the area and capillaries running abnormally close to the foveal region. OCT scan in the past. A lack of patient awareness was found concerning ORTHOPTISTS AND ORTHOPTICS IN THE WAR YEARS, 1939-1945 multidisciplinary vision care experts to be part of routine stroke Isolated foveal hypoplasia is often subtle and difficult to detect however, low vision services and support groups, irrespective of public versus assessment. Stroke units in two metropolitan Sydney public hospitals other accompanying signs may include nystagmus, poor visual acuity, private status. Not surprisingly, service uptake was also low with only one Shayne Brown with no access to on-site eye care professionals, participated in the study. aniridia, albinism, microphthalmia and achromatopsia. This case looked patient enrolled in a patient support group and few patients aware of low Patients admitted to these units for a minimum of three days were eligible at the initial presentation, investigations and suspected diagnosis of foveal vision services available to them. Factors influencing the uptake of low When war broke out in September 1939 the exact number of trained for recruitment. Participants were allocated randomly to one of two hypoplasia. vision rehabilitation services and patient support groups (as identified by orthoptists in Australia was unknown. At least six were in Sydney, at least groups. In Group 1, a detailed visual assessment by an experienced eye patients) included: timing of referral, financial outlay, perceived benefit/s, four in Melbourne, one in Adelaide and one in Hobart. The profession was care practitioner (orthoptist) was compared to information elicited by the and accessibility. Referral rates were low amongst orthoptists. Barriers to in its infancy. The Orthoptic Association of Australia (OAA) was yet to be tool when administered by a non-eye practitioner. In Group 2, the vision HOW DO WE COMMUNICATE WITH OUR PATIENTS? the referral of patients to low vision services and patient support groups formed and the Orthoptic Board of Australia (OBA) was barely a year old. screening tool was administered by both the orthoptist and practitioner for (as identified by orthoptists) included: practical factors, knowledge-based Research by Canadian born, British ophthalmologist, Air Commodore Sir comparison. This study had institutional ethical approval. Catherine Devereux factors, patient factors and clinical protocol. Philip Livingston developed visual standards required for trainee aircrew Conclusion: Despite treatment adherence typically being high in patients in the Royal Air Force (RAF) and these standards were mainly adopted by Results: 100 participants were recruited; analysis showed the tool was Increasingly, health providers are expected to partner with their patients undergoing anti-VEGF injections for neovascular AMD, patient satisfaction the Royal Australian Air Force (RAAF). Livingston had found that some highly successful in ascertaining pre-existing eye conditions. While the in the delivery of health care services. Person-centred practice puts the with the level of educational information provided was low, especially trainee pilots with poorly controlled heterophorias displayed inaccuracies tool is able to detect obvious newly acquired visual problems, subtle consumer (patients, family and their carers) at the centre of their care in public patients. Many patients felt uninformed about the treatment in depth perception which affected their ability to land their aircraft conditions are more likely to be missed. by including them in decision making and focusing on their unique and individual needs. Patients tell us that they want timely care, respect, positive process and reported limited knowledge of support services available to safely. He was a strong advocate for orthoptic treatment. This was a Conclusion: The vision screening tool is suitable and a valid instrument communication and to feel supported. Based on a series of consumer- them. Improving the standards of patient education may help lessen pre- controversial matter both in England and in Australia. However Australian for achieving its designated purpose of identifying pre-existing and newly led projects this presentation addressed communication as the integral procedural anxiety and assist patients to better manage the challenges of ophthalmologist, Joseph Ringland Anderson, argued for the inclusion acquired visual problems in patients with a diagnosis of stroke. It is AMD treatment. of orthoptic investigation and treatment for aircrew trainees under the component in building effective relationships with patients and their

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families. How we talk with consumers and consider their understanding RISK FACTORS FOR LONGITUDINAL BIOMETRIC AND REFRACTIVE TAKE TWO APPS AND TWEET ME IN THE MORNING: HEALTHCARE IN Methods: This was a cross-sectional study of 483 children and adolescents of health information is pivotal to empowerment and maximising health CHANGE IN AUSTRALIAN SCHOOLCHILDREN A DIGITAL WORLD with type 1 diabetes. The medical files of participants who had retinal outcomes. The Teach Back technique will be outlined and encouraged as a images taken were audited to collect all relevant clinical data. Diabetic useful method to ‘confirm that you have explained to the patient what they Amanda French, Kathryn Rose Michelle Gallaher retinopathy was assessed from colour retinal images by an ophthalmologist need to know in a manner that the patient understands’. according to the Modified Airlie House classification system. Purpose: To investigate longitudinal change in biometry and refraction and Social media and the internet of things is playing an increasing role examine the impact of risk factors in Australian schoolchildren. in healthcare delivery, and practitioners and providers can no longer Results: Diabetic retinopathy was observed in 11 (2.3%) participants. ORTHOPTISTS DRIVING CLINICAL IMPROVEMENTS VIA THE SAVE afford to ignore its value. Initially seen as a detrimental distraction and Univariate analysis revealed a higher mean HbA1c (M=9.2±1.6 vs SIGHT REGISTRIES (SSR) Methods: The Sydney Adolescent Vascular and Eye Study followed up a source of misinformation by many healthcare providers, social media 8.3±1.3; p=0.008) and BMI (M=27.4±5.2 vs 23.1±4.6; p=0.009), and participants (6 years; N=1,765 and 12 years; N=2,353) from the Sydney is fast becoming a primary tool for many clinical researchers, medical lower serum HDL cholesterol (M=1.2±0.3 vs 11.5±0.3; p=0.006) in Amanda Dinh, Amparo Herrera-Bond, Phuc Nguyen, Mark Gillies, Myopia Study, 5 to 6 years after initial examination. Children underwent technology developers, healthcare providers and patients. Digital health participants with diabetic retinopathy. Logistic regression revealed that Stephanie Watson a comprehensive ocular examination including cycloplegic autorefraction and the opportunity these platforms offer to orthoptics and ophthalmology the principal components analysis derived risk profile of: higher serum (Cyclopentolate 1%, Canon RK-F1). Change in spherical equivalent is being transformed, literally before our eyes. Vision technologies and creatinine, older age, higher SBP, higher BMI, abnormal eGFR (<59 ml/ Background: The SSR is a sophisticated web-based data system used refraction (SER) and biometry for the right eye were analysed and the patient engagement opportunities are emerging in the market, built upon min), lower HDL cholesterol, higher serum sodium, longer duration worldwide to collect data on the outcomes of therapy for eye disease, impact of risk factors examined. smartphone platforms. Social media platforms, particularly Facebook of diabetes and narrower retinal arteriolar calibre was associated with including patient reported treatment outcomes. Modules are currently and Twitter, are seeking to serve clinical researchers and patients who diabetic retinopathy (ExpB=2.60, 95% CI 1.36-4.96, p=0.004). available for macular degeneration (nAMD), diabetic retinopathy Results: There was a significant negative shift in mean refraction between are vision impaired and clinical researchers looking for engagement and and keratoconus. Outcomes data collected via the registry is driving baseline and follow-up (both cohorts p<0.0001) associated with increases Conclusions: These results support the concept that the pathogenesis of data. The rise of digital health is transforming the sector with technologies diabetic retinopathy is likely due to the combined influence of various risk improvements in patient care and providing a clear picture of the patient in axial length (AL), anterior chamber depth (ACD) and axial length/corneal that are disrupting the major players in the medtech market with cheaper, journey. Orthoptists play a key role facilitating the use and growth of this radius ratio (AL/CR). Children of East Asian ethnicity and those with myopic factors, many already identified. Furthermore, the results of univariate easier and more sympathetic approaches improving compliance, access and multivariate analysis provide novel evidence for the possible benefit significant registry and providing patient education on the outcomes of parents had greater changes in refraction and biometry (all p<0.0001). and outcomes. Examples were introduced of high value social media and of more intense management of diabetic retinopathy for persons with a their eye disease and treatment course. Children who spent more time in near work also had larger increases in IofT technologies such as Research Kit and IBM Watson, and ways in low HDL level. Method: A review of the current procedures for implementation of the AL and AL/CR, although this was significant only in the older cohort (AL, which regulation, legislation, quality clinical evidence, market access and SSR was conducted utilising the keratoconus module. Key roles for the p=0.02 and AL/CR, p=0.03). Conversely, spending greater time outdoors reimbursement need to keep pace with the way patients and practitioners orthoptist were identified. Data collected from the keratoconus module was reduced AL growth in the younger (high=0.71 mm, moderate= 0.77 are engaging online, specifically in vision sciences, were discussed. CHILDREN REFERRED FOR TERTIARY CARE AT THE CHILDREN’S used to illustrate the role of the orthoptist for the Save Sight Registries. mm and low=0.86 mm, p<0.0001) and older cohort (high=0.22 mm, HOSPITAL AT WESTMEAD FROM COMMUNITY-BASED moderate=0.26 mm and low=0.28 mm, p=0.008), as well as AL/CR (both SURVEILLANCE WITH COMPLEX NEURODEVELOPMENT AND Results: 116 key roles for the orthoptist were identified. Orthoptists p<0.0001). GOLDMANN APPLANATION TONOMETRY AUDITS (RVEEH) ADDITIONAL NEEDS identified as being actively involved with data input from patients in real- Conclusion: Greater time spent in near work increased refractive and life clinical settings, facilitating the collection of patient reported outcomes Debra Gleeson Lindley Leonard, Louise Brennan via survey, reviewing treatment outcomes with the ophthalmologist biometric change but, this was significant for the older cohort only. More Raised intraocular pressure (IOP) has been shown to be a significant risk and patient education. Interests in the SSR have been encouraging time spent outdoors slowed AL/CR change and AL elongation in both With the initiation of a pilot clinic in 2010 there has been an evolution factor for glaucomatous damage and progression. The goal for treating with increasing implementation across various centres nationally and cohorts, although the impact appeared greater at a younger age. in the management of children seen within a busy outpatient combined internationally. The database for nAMD has grown from 293 patients patients with glaucoma is to lower the IOP to a targeted pressure to reduce orthoptic/ophthalmology service. Changes have been evident in referral in 2009, to 5,500 patients, 7,109 eyes in 2016 with a total of 146,159 the risk of further damage. Goldmann applanation tonometry (GAT) is the patterns including a noticeable increase in referral of children with treatments. Likewise, there are already 261 treatments captured and 851 THE USE OF BLENDED LEARNING TO INCREASE ORTHOPTIC gold standard for measuring IOP and accuracy performing this test is of complex neurodevelopment and additional needs being assessed within eyes in the Keratoconus Module. STUDENTS’ ACCEPTANCE AND SUCCESS IN EVIDENCE-BASED high importance. It had been noted on the RVEEH EGTH glaucoma clinic the community, requiring appropriate ophthalmology assessment. This PRACTICE LEARNING that there was some disparity between the IOP measurements taken by has required us, as orthoptists, to consider a model of service delivery Conclusion: SSR is a unique system empowering orthoptists with clinical the orthoptists and those measured later by the glaucoma consultants. An to accommodate children that previously have not been reviewed within knowledge. It is driving improvements in ophthalmology by tracking Amanda French, Kathryn Rose audit was undertaken over a three-week period to note the number and this particular clinic. Discussion highlighted modifications within the outcomes of treatment in real life clinical settings with a patient focused range of disparity in the IOP measurements. A professional development service and a number of cases that confirmed the necessity of a thorough approach. Orthoptists registered in the system are self-educating and Purpose: This study aimed to assess the impact of blended learning on opportunity was provided on several occasions for the orthoptic staff to assessment whilst considering adaptations for children with additional becoming more actively involved in patient care and the patient’s treatment student acceptance and success in learning evidence-based practice (EBP). outline the many factors affecting measurement and how to improve needs. journey and in turn, professional development. technique. An audit of IOP readings was conducted in 2016 after two of Method: Blended-learning was introduced to increase student engagement these teaching sessions. in EBP subjects in the Master of Orthoptics course in Sydney. Student EARLY LIFE RISK FACTORS OF AMBLYOPIA, STRABISMUS AND THE AUSTRALIAN ORTHOPTIC BOARD AND YOU acceptance was assessed quantitatively through formal subject evaluation ANISOMETROPIA IN A YOUNG ADULT POPULATION scores and qualitatively through thematic analysis of student survey THE TED TALK: AN OVERVIEW AND CASE PRESENTATIONS Kerry Fitzmaurice comments. The contribution of blended learning to student success was Gareth Lingham, Seyhan Yazar, Paul Sanfilippo, Jenny Mountain, Alex investigated by analysis of grades. Lindsay Horan Historically the orthoptic profession in Australia was regulated by the Hewitt, John Newnham, David Mackey Orthoptic Board of Australia, a sub-committee of the Royal Australian Results: In 2010, student acceptance of learning EBP was low with only 37% Thyroid eye disease is autoimmune disorder that can lead to dysfunction Aim: Amblyopia, strabismus and anisometropia are childhood diseases that and New Zealand College of Ophthalmologists (RANZCO). The Board satisfied with the research subject. With the introduction of a preparatory of multiple organ systems. Its effect on the eye can be mild to very severe. frequently co-occur. We investigated the underlying possible early life risk members included ophthalmologists and orthoptists and the functions subject incorporating blended learning in 2011, student satisfaction with The eye muscles are often involved, leading to eyelid retraction, dry eye, factors associated with these three conditions in 20-year-old individuals. included conferring the entry to practice qualification – Diploma of the the semester 2 subject increased to 56%, although student comments and restrictive strabismus. In this presentation, an overview of thyroid Orthoptic Board of Australia, and to ensure professional standards. As the suggested that the relevance was not well understood: ‘I do not at all see eye disease, including its ocular manifestations and natural history, was Methods: The Western Australian Pregnancy Cohort (Raine) Study is a cohort study of individuals born between 1989 and 1991. During orthoptic profession developed, having professional standards regulated the relevance to my degree and how this knowledge will be used in my provided. In addition, case presentations illustrated the disease course and prenatal period, parents of these individuals completed comprehensive by another professional body became inappropriate. The preferred position career as an orthoptist’ (student, 2011). With further refinement of the management. was regulation under government legislation however as this was not questionnaires on medical history, life style and environmental exposures. curriculum, student satisfaction increased to 87%, 100% and 81% in 2012, possible the agreed option was to form an independent body that would At the 20-year follow-up, 1,344 participants underwent an extensive 2013 and 2014 and comments indicated a greater understanding of the be recognised nationally in a court of law. The Australian Orthoptists PREVALENCE AND RISK FACTORS FOR DIABETIC RETINOPATHY IN eye exam including a complete orthoptic assessment. Risk factors were relevance. Student grades for the final research subject also increased, Registration Body Pty Ltd was formed with a sub-committee – the A HOSPITAL-BASED POPULATION OF AUSTRALIAN CHILDREN AND explored for each condition by comparing with a disease-free control with the failure rate dropping and an upward shift in the mean grade. Australian Orthoptic Board (AOB). The current AOB provides independent ADOLESCENTS WITH TYPE 1 DIABETES group. Identified differences were further investigated using univariate oversight of the quality of orthoptic practice by: accrediting the university Conclusion: The use of blended learning strategies to encourage orthoptic and multivariate regression models. training programs for orthoptists in Australia; assessing the equivalence Stuart Keel, Catherine Itsiopoulos, Konstandina Koklanis, Meri students’ engagement has significantly increased student acceptance and Results: Of 1,128 participants of Northern European ancestry, 14 (1.2%) of non-Australian qualifications; regulating professional development and Vukicevic, BOrth, Fergus Cameron, Laima Brazionis success in their learning of EBP. This is likely to translate into greater had amblyopia, 47 (4.2%) had clinically significant strabismus and 34 providing disciplinary procedures and actions in the case of professional engagement in EBP and research as orthoptic graduates. Aim: To investigate the prevalence, and traditional and emerging risk (3.0%) were anisometropic. The frequency of individuals born via normal misconduct. The role of the AOB in professional regulation was discussed. factors associated with retinopathy in a hospital-based population of delivery was consistently lower in amblyopia (42.9%), esotropia (40.7%), Australian children and adolescents with type 1 diabetes. exotropia (50%) and anisometropia (58.8%) groups compared to control

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Aust Orthopt J 2016 Vol 48 © Orthoptics Australia Aust Orthopt J 2016 Vol 48 © Orthoptics Australia 40 AUSTRALIAN ORTHOPTIC JOURNAL AUSTRALIAN ORTHOPTIC JOURNAL

(78.3%) (all p<0.001). Birth by caesarean section was associated with vests, there is a large gantry erected off the side of the hospital and there A NOVEL METHOD FOR MEASURING NYSTAGMUS A RETROSPECTIVE STUDY TO IDENTIFY FACTORS THAT INFLUENCE increased likelihood of having amblyopia after adjusting for sex (OR: is dust and noise and vibration. This is all because we are undergoing a CLINICAL ADHERENCE RATES IN PATIENTS WITH DIABETIC 2.28, 95% CI: 2.08-2.49, p<0.001). Occipitofrontal diameter, median major redevelopment which will bring our facilities into the 21st century. Cem Oztan MACULAR OEDEMA UNDERGOING INTRAVITREAL INJECTION gestational age and duration of first stage of labour and delivery mode Although these changes are significant they are not the only changes TREATMENT Nystagmus is the involuntary repetitive rhythmic oscillation of the were all associated with strabismus in univariate analyses (all p<0.05). taking place. Significant clinic redesign activities have also taken place. In eyes. The movements of the eyes are commonly from side to side, but order to achieve this, we have had to look at: i. how The Royal Victorian Monique Rose, Catherine Itsiopoulos, Meri Vukicevic, Konstandina Conclusion: Among the long list of risk factors we investigated, non-vaginal sometimes can be up and down, clockwise and counter clockwise rotation Eye and Ear Hospital transitioned from an undifferentiated general eye Koklanis, Gwyneth Rees, Suki Sandhu delivery was associated with amblyopia, strabismus and anisometropia in or any combination of these. Additional characteristics of nystagmus our Western Australian cohort. This study supports the hypothesis that clinical service to the Surgical Ophthalmology and Acute Ophthalmology include type, whether pendular or jerk, amplitude, frequency, intensity, Diabetic macular oedema (DME) is due to leakage of fluid from damaged abnormal delivery methods may be related to common childhood eye specialist eye services; ii. the use of data to support well informed service foveation, conjugate/disconjugate and presence of a null point. Nystagmus blood vessels. Vascular endothelial growth factor (VEGF) is elevated diseases. decisions, and iii. defining clinic role and patient pathways – a compelling in infancy and childhood can be idiopathic or associated with ocular or in eyes with DME, and drives vascular leakage. Centre-involving sight- narrative for change. systemic conditions. It is a common cause of vision impairment, resulting affecting DME is currently treated with intravitreal anti-VEGF injections. in variable classifications from near normal vision to profound low vision. It is a commonly performed procedure, which involves multiple injections PAPILLOEDEMA: TRUE SWELLING, DRUSEN IN DISGUISE ... OR BOTH? A REVIEW OF StEPS OUTCOMES The clinician is faced with a unique challenge of examining and treating every four to six weeks until the fluid is resolved and may be continued patients with nystagmus. The aim of this presentation was to briefly review indefinitely to maintain vision. To date no studies have identified clinical Melanie Lloyd current eye movement recording techniques used in nystagmus such as attendance rates and explored personal and clinical factors that influence Danielle Morgan Children are often urgently referred to the ophthalmology department electrooculography, electronystagmography and video eye/gaze tracking attendance and non-attendance in patients with DME receiving intravitreal with ‘papilloedema’. This presentation took a closer look at the The Statewide Eyesight Preschool Screening program (StEPS) provides devices, and evaluate a novel method for measuring nystagmus which injection treatment. Studies have primarily focused on the barriers and literature regarding the prevalence, diagnosis and management of free vision screening for all 4-year-old children in NSW. The program can be used in clinic and applied to the assessment phase and treatment incentives to attend diabetic retinopathy screening. A retrospective idiopathic intracranial hypertension and drusen, as well as the necessary targets children before starting school to maximise the potential for success of nystagmus patients. study utilising data from medical records of DME patients who attended investigations required to differentiate between them. visual improvement during the critical period of visual development. This (patients who attended all appointments) and did not attend (patients who missed one or more appointments in the previous 12 months) the eye presentation explored outcomes from the Sydney Children’s/Prince of ORTHOPTICS IN AN OPHTHALMIC CLINIC clinic between 1st January 2014 to 31st December 2014 was identified Wales Hospital StEPS clinics over the last few years and focused on the THE ROLE OF OCULAR ELECTROPHYSIOLOGY IN AUTOIMMUNE from The Royal Victorian Eye and Ear Hospital medical retina injection importance of encouraging patient attendance and the need for orthoptic RETINOPATHIES Becc Page, Shandell Wishart clinic and retinal clinics at the Cheltenham Eye Centre. A telephone screening in the StEPS program. survey was conducted to gain patients’ perspectives on attendance and It is nearing the middle of a busy, four doctor clinic and a new patient has Jo Lynch non-attendance. The attendees were asked one open-ended question and presented to a retinal specialist with a 6th nerve palsy – they turn to you non-attendees two open-ended questions. Data analysis has commenced Autoimmune retinopathies such as MAR (melanoma associated retinopathy) DIABETIC RETINOPATHY IN PREGNANCY: A REVIEW for your expert opinion on how to manage this patient. What do you do!? and results will be presented. This person-centred approach will inform and CAR (cancer associated retinopathy) are rare conditions but need to Working within a busy ophthalmic practice, we saw a need to follow in strategies for patient education and support to minimise non-attendance be considered in patients who present with rapidly progressive, bilateral, Julie Morrison, Lauren Hodgson, Lyndell L Lim, Salmaan Al-Qureshi the footsteps of several public hospitals and set up orthoptic-only clinics in patients with diabetes-related eye complications. painless vision loss, particularly if they have a history of cancer. Symptoms to provide one-on-one care to patients who require an in-depth orthoptic The prevalence of diabetes in Australia has more than doubled in 20 may include visual field defects, nyctalopia, photopsias and defective assessment that cannot be provided within the confines of an ophthalmic years. The prevalence of diabetes in pregnancy is increasing even more colour vision. Extensive testing is required to exclude other causes such clinic. These sub-contracted clinics allow ocular motility patients to GEOGRAPHIC ATROPHY IN THE CLINICAL TRIAL WORLD as genetic conditions and electrophysiology has an important role to play. rapidly due to increasing gestational age and the increasing prevalence, be seen at a more suitable time and managed by their orthoptist on an and younger age of onset of type 2 diabetes in the population. Pre-existing ongoing basis. This presentation aimed to explain how we got our clinics Sutha Sanmugasundram diabetes is present in 1 in 167 pregnancies in Australia, divided equally up and running, what challenges we faced along the way and why this ROYAL VICTORIAN EYE AND EAR HOSPITAL AND ACO between type 1 and type 2 diabetes. Diabetic retinopathy is a leading cause model could be useful to many other clinicians working in an ophthalmic Age-related macular degeneration (AMD) is a progressive eye disease, COLLABORATIVE CLINIC - A NEW MODEL OF CARE FOR LOW RISK of blindness in women during their childbearing years and pregnancy setting. which is the leading cause of irreversible blindness in people aged 50 GLAUCOMA PATIENTS increases the short-term risk of diabetic retinopathy progression. We years and older in the developed world. There are two clinical forms of examined the risk factors for progression of diabetic retinopathy during AMD: a non-exudative or dry form, geographic atrophy (GA), and an Linda Malesic, Catherine Green, Caroline Clarke, Tracy Siggins, Sharon pregnancy including; duration of diabetes, baseline level of retinopathy, FINGOLIMOD (GILENYA) SCREENING AT THE ALFRED HOSPITAL exudative or wet form. GA affects roughly five-million people worldwide Bentley, Maureen O’Keefe level of glycaemic control and hypertension. We also examined current and its occurrence increases exponentially with age. Although the cause of GA is not well understood, studies have shown that specific screening and management guidelines and their levels of evidence, Alannah Price To develop a sustainable clinical model of care for the management of genetic characteristics and environmental factors may contribute to its current treatment options for diabetic retinopathy and avenues for further glaucoma suspects involving a collaboration between the Royal Victorian In 2013 at the Alfred Hospital an Orthoptic Drug Screening Clinic was development and progression. In the early stages of GA, patients typically Eye and Ear Hospital (RVEEH) and the Australian College of Optometry research. established to screen and monitor ocular changes associated with the use show minimal changes in their central visual acuity. Patients can also (ACO). The Glaucoma Collaborative Clinic (GCC) was established in April of plaquenil, ethambutol and fingolimod (Gilenya) medications. Gilenya experience symptoms from visual dysfunction including dense parafoveal 2016, at the ACO’s main clinic in Carlton, Melbourne. The clinic utilises 0.5mg was approved for use in Australia by the Therapeutic Goods THE ORTHOPTIC-LED DIABETIC SCREENING CLINIC AT THE ALFRED scotomas, delayed dark adaptation and reduced contrast sensitivity. In the the full scope of eye care professionals, ophthalmologists, optometrists and Administration (TGA) in February 2011 and placed on the Pharmaceutical later stages, as the GA lesion expands into the fovea, a significant decrease HOSPITAL orthoptists, to provide eye care the numerous public patients suspected of Benefits Scheme (PBS) in September 2011 for the treatment of relapsing in central VA occurs. Currently there are no approved medical treatments having glaucoma. The service has been developed with a focus on providing forms of multiple sclerosis (MS). Collective data from clinical trials found for GA, however there are several clinical studies investigating treatment the most appropriate care at the most appropriate time in the patient Mercy Nguyen the incidence of macula oedema associated with the use of 0.5mg of Gilenya to reduce the rate of GA progression and vision loss. At CERA, we are journey. This presentation outlined how this new clinic has involved new In 2014, the ophthalmology department at the Alfred Hospital introduced to be 0.4% of participants. It is therefore recommended that patients who currently partaking in five different sponsored clinical studies for GA, with three trialling three different investigational drugs and two studying the collaborative models and pathways to eye care, building on and bringing an orthoptic-led diabetic screening clinic. This clinic was developed commence Gilenya have an eye exam to assess macula oedema within the first 3 to 4 months of commencing the drug. An overview of the protocols natural history of these patients. This presentation briefly outlined the together the skills and experience of both the RVEEH and ACO to deliver in response to the increasing demand required to care and monitor the and procedures for Gilenya screening in the Orthoptic Drug Screening three different investigational products being trialled and the differences the best outcomes for patients. In addition, the ways in which the new GCC ocular health of those with diabetes. It allows the orthoptist to be more has provided scope for the clinical training of orthoptists and optometrists Clinic was discussed. and benefits of participating in both treatment and non-treatment trials. actively involved in patient care and management, as well as provide a in a unique collaborative environment will be presented. more efficient and effective way of dealing with the ever-growing diabetic health concern. Through this diabetic screening clinic, results have shown BULA! ORTHOPTISTS IN FIJI 2015 HOW TO WRITE A CASE REPORT FOR THE AUSTRALIAN ORTHOPTIC SPECIALIST CLINIC REDESIGN AT THE ROYAL VICTORIAN EYE AND that patients receive a more thorough and comprehensive assessment JOURNAL EAR HOSPITAL than previously, as well as more appropriate regular eye appointments. Maria Pritchard, Tony Wu This presentation outlined the protocols and procedures that have been Linda Santamaria Last November a group of volunteer medical and allied health professionals Catherine Mancuso, Tracy Siggins implemented through this screening clinic and the benefits it has provided visited the Coral Coast in Fiji to provide a range of health based services Are you thinking of writing for the Australian Orthoptic Journal, but not both to the patients and to the productivity of clinics. sure where to start? For the beginning writer, this could be with a case The Royal Victorian Eye and Ear Hospital (RVEEH) is changing. Anyone and education to the local community. The two orthoptists provided vision report, or an outline of a new model of care. This presentation outlined the who works there or has visited in the past four years can see that. There screening, education and glasses. The experience of these orthoptists was process of preparing a case report for submission to the journal, with hints are workmen walking through the hospital in their hard hats and high-vis presented. on ethics considerations, literature searching, reading and writing.

Aust Orthopt J 2016 Vol 48 © Orthoptics Australia Aust Orthopt J 2016 Vol 48 © Orthoptics Australia AUSTRALIAN ORTHOPTIC JOURNAL AUSTRALIAN ORTHOPTIC JOURNAL 41

Aust Orthopt J 2016 Vol 48 © Orthoptics Australia Aust Orthopt J 2016 Vol 48 © Orthoptics Australia 42 AUSTRALIAN ORTHOPTIC JOURNAL AUSTRALIAN ORTHOPTIC JOURNAL

OCULAR TORSION IN STRABISMIC PATIENTS AND HOW IT AFFECTS Conclusion: Timely genetic counselling and testing for individuals with a THEIR BINOCULAR POTENTIAL personal or family history of RB is an integral part of optimal clinical care. Named Lectures, Prizes and Awards This multidisciplinary approach to care and surveillance is vital to ensure Angela Serna the earliest diagnosis and treatment for optimal outcomes. of Orthoptics Australia We prospectively looked at 40 patients who presented to our clinic with binocular diplopia. Using a Clement Clarke synoptophore, we assessed how many of these patients presented with ocular torsion and how this impacted their binocular potential by testing Worth’s three grades of THE PATRICIA LANCE LECTURE binocular vision. Clinically, we have seen that small negligible amounts of torsion can often affect a patient’s binocularity, especially their horizontal 1988 Elaine Cornell Home exercises in orthoptic treatment fusional amplitudes and stereopsis. Often these patients are unable to fuse 1989 Alison Pitt Accommodation deficits in a group of young offenders with prisms, they demonstrate intermittent fusion or report a somewhat 1990 Anne Fitzgerald Five years of tinted lenses for reading disability ‘single’ but blurred image when corrected with prisms or post-surgically. 1992 Carolyn Calcutt Untreated early onset esotropia in the visual adult These patients often will not complain of torsional diplopia and ocular 1993 Judy Seaber The next fifty years in orthoptics and ocular motility motility testing does not always indicate the presence of a superior oblique 1995 David Mackey The Glaucoma Inheritance Study in Tasmania (GIST) palsy. 1997 Robin Wilkinson Heredity and strabismus 1998 Pierre Elmurr The visual system and sports perfomance 1999 Kerry Fitzmaurice Research: A journey of innovation or rediscovery? NEW OCT SIGNS IN INTERMEDIATE AMD 2005 Kathryn Rose The Sydney Myopia Study: Implications for evidence based practice and public health 2006 Frank Martin Reading difficulties in children - evidence base in relation to aetiology and management Pyrawy Sharangan 2008 Stephen Vale A vision for orthoptics: An outsider’s perspective 2009 Michael Coote An eye on the future Age-related macular degeneration (AMD) is the leading cause of vision 2010 John Crompton The pupil: More than the aperture of the iris diaphragm loss in people aged fifty years and over in Australia. AMD has relatively 2011 Neryla Jolly On being an orthoptist slow progression from the early to the advanced stage therefore leaving 2012 Shayne Brown A snapshot of orthoptics from the 1960s to 2000 a window of opportunity for early intervention. With the advancement 2013 Sue Silveira Finding the leader within of available technology and introduction of high resolution imaging 2014 Patricia Dunlop A life in orthoptics techniques, we are now able to detect and analyse new characteristics of 2015 Fiona Rowe The spectrum of post-stroke visual impairment AMD that may assist with better understanding the disease. Through this 2016 Linda Santamaria 50 years: The development of research and publication in the Australian Orthoptic Journal we would be able to detect high-risk signs that indicate a subgroup more likely to progress to vision loss. The spectral domain optical coherence tomography (SD-OCT ) is one such device with the ability to help identify THE EMMIE RUSSELL PRIZE additional risk features. This presentation focused on three features that have been identified through our longitudinal studies: nascent geographic 1957 Margaret Kirkland Aspects of vertical deviation atrophy, reticular pseudodrusen and non-exudative detachment of the 1959 Marion Carroll Monocular stimulation in the treatment of amblyopia exanopsia neurosensory retina. 1960 Ann Macfarlane A study of patients at the Children’s Hospital 1961 Ann Macfarlane A case history “V” Syndrome FAMILIAL RETINOBLASTOMA AND GENETIC TESTING: A PARADIGM Margaret Kirkland Surgical cases of intermittent divergent strabismus SHIFT IN CLINICAL CARE 1962 Adrienne Rona A survey of patients at the Far West Children’s Health Scheme, Manly 1963 Madeleine McNess A survey of the use of miotics 1965 Margaret Doyle Diagnostic pleoptic methods and problems encountered Sandra Staffieri, Lisa Kearns, James Elder, John McKenzie, Lisette 1966 Gwen Wood Miotics in practice Curnow, David Amor, Alex Hewitt, David Mackey 1967 Sandra Hudson Shaw Orthoptics in Genoa Background: Retinoblastoma (RB) is the most common intraocular 1968 Lesley Stock Divergent squints with abnormal retinal correspondence malignancy occurring in children. The RB1gene was first identified in 1969 Sandra Kelly The prognosis of the treatment of eccentric fixation 1986 with genetic testing for RB translating to clinical care by the end 1970 Barbara Dennison A summary of pleoptic treatment and results of the 1990s. This heralded a paradigm shift in the clinical management 1971 Elaine Cornell Paradoxical innervation of affected individuals by informing their clinical care and that of their 1972 Neryla Jolly Reading difficulties siblings and offspring. 1973 Shayne Brown Uses of fresnel prisms 1974 Francis Merrick The use of concave lenses in the management of intermittent divergent squint Aim: To report on the frequency and outcomes of the use of pre- and 1975 Vicki Elliott Orthoptics and cerebral palsy post-natal genetic testing for familial retinoblastoma using the Victorian 1976 Shayne Brown The challenge of the present Retinoblastoma Database cohort since 1998. 1977 Melinda Binovec Orthoptic management of the cerebral palsied child Methods: Retrospective audit of the Victorian Retinoblastoma Database. 1978 Anne Pettigrew 1979 Susan Cort Nystagmus blocking syndrome Results: Twenty-six infants were born of 13 individuals with a personal or 1980 Sandra Tait Foveal abnormalities in ametropic amblyopia family history of RB. Only four of the 13 parents elected to undergo pre- 1981 Anne Fitzgerald Assessment of visual field anomalies using the visually evoked response natal testing for seven pregnancies. Pre- or post-natal genetic testing was 1982 Anne Fitzgerald Evidence of abnormal optic nerve fibre projection in patients with dissociated vertical deviation: A preliminary report completed in 19 pregnancies. Of these, 12 (63%) infants were found to 1983 Cathie Searle Acquired Brown’s syndrome: A case report carry the familial RB1 mutation, six of whom remain unaffected carriers. Susan Horne Acquired Brown’s syndrome: A case report Five of the unaffected carriers are from two known low-penetrant families. 1984 Helen Goodacre Minus overcorrection: Conservative treatment of intermittent exotropia in the young child The gestational age at which the first lesions developed in all the affected 1985 Cathie Searle The newborn follow up clinic: A preliminary report of ocular anomalies infants ranged from 35 to 43 weeks (mean 40 weeks). One pregnancy was 1988 Katrina Bourne Current concepts in restrictive eye movements: Duane’s retraction syndrome and Brown’s syndrome induced due to the identification of lesions prenatally with intrauterine 1989 Lee Adams An update in genetics for the orthoptist: A brief review of gene mapping MRI. With treatment, 21 eyes of 12 affected children have been retained. 1990 Michelle Gallaher Dynamic visual acuity versus static visual acuity: Compensatory effect of the VOR